Periodontal Patient Education

Your gums’ analysis made easy and understandable

We employ a color code to classify our patients’ gums status. We often refer to a patient as a “blue” patient, or a “green” patient, or a “yellow” or “red” patient. We do this to eliminate the complexity of dental diagnosis and to simplify patient education. Consider the following analogy:

BLUE PATIENTS You are driving your car on a vast, open road. There are no foreseeable dangers. The sky is a beautiful color blue.

Translation: Your gums are very healthy. Pocket depths (in the 1 to 3 mm range) do not show bone loss, and ONLY because of this can the patient afford less treatment. In this patient, plaque and tartar accumulation has had a relatively low impact on gum health.

Recommended treatment: A “regular” cleaning done every 4 to 6 months is enough to clean and maintain this patient’s condition. Careful monitoring is essential as this condition can change in as little as 6 months! Preventive maintenance is the key to success here.

GREEN PATIENTS But now, on the road ahead, you approach an intersection. The light is green. You know you have the right-of-way and that you can proceed relatively worry-free. But the smart driver knows to be careful. After all, you are approaching an intersection; someone may barge in your way (a pedestrian or a truck) and your situation may become serious really fast.

Translation: You have gingivitis. Your gums begin to show redness and stress from exposure to plaque and tartar. They get inflamed and swollen, and they bleed easily (although even occasional bleeding from the gums is significant). When one measures the pockets between your teeth and gums, one can find depths around 4mm deep. Bone loss is still not apparent. But it is certainly to begin if one does not adopt a serious program of prevention because at 4mm under the gum you are indeed at a crossroads. Bacteria in these pockets are mostly “anaerobic” (they live in the absence of air or oxygen). And once established, they are very difficult to eradicate.

Recommended treatment: This mouth will need more than a “regular” cleaning. The initial treatment consists of a “sub-gingival debridement.” This is a thorough removal of not only all the hardened debris under the gums, but also of the infected, unhealthy, red gum tissues which line the pocket. Patient’s response is re-evaluated 4 to 6 weeks later. “Regular” cleanings begin at 3- or 4-month interval after the initial therapy, and continue throughout the first year depending on your particular needs. Close monitoring is essential. Remember, you should seek a professional, preventive cleaning before your mouth gets dirty again. This 4mm pocket can only get worse with continued plaque accumulation and it will quickly lead you to “periodontitis,” which is the hallmark of bone loss and an irreversible condition.

YELLOW PATIENTS The signal light ahead of you now turns yellow. How fast are you going? Can you stop? How busy is the traffic there? How much trouble can you get into here?

Translation: You have “early to moderate periodontitis.” Warning! There already is bone loss! Many factors are now involved: Apathy (“... I have a terrible mouth, nothing can be done”), poor oral hygiene habits, resistance to good nutrition, non-compliance with frequent cleanings, denial (“...this may happen to other people but not me!”) and my personal favorite...“If I speed up some more, I’d might beat the red light.” Let’s hope there isn’t a cop nearby! Periodontal (gums) pockets now 5 to 6 mm deep harbor bacteria that are so harmful to your mouth that if not properly removed can cause an additional millimeter of bone loss in as little as 3 months. The situation is indeed critical. Our recommendation is to STOP on this yellow light and spare yourself an “accident.”

Recommended treatment: A thorough “deep cleaning” is done first. Patients are asked to have this procedure in one visit (full-mouth) or in two (half-mouth). During these visits all the debris under the gums is removed. This is done without anesthesia thanks to a new ultrasonic probe that works under the threshold of pain. All pockets are charted carefully, so that the dentist and hygienists know what the initial condition looked like prior to treatment. A very important “re-evaluation” appointment is scheduled 4 to 6 weeks after. At this time, all pockets are re-measured and the improvement is documented. Special antibiotics and antibacterial rinses may be prescribed. Preventive, maintenance cleanings are done strictly every 3 months. At this point, the most important role of the dentist and his staff is to educate the “yellow” patient about gum disease, to teach this patient how to properly maintain his or her mouth at home, and to stress the importance of having professional cleanings at regular 3-month intervals for as long as he or she lives!!! For the pocket is already there; the bone loss exists and will not improve, and the condition is permanent.

RED PATIENTS The light now turns red, and you must stop!

Translation: You have “moderate to advanced periodontitis.” Your very serious attention to this problem is now requested. No more excuses or justifications. The time to act is NOW.

Recommended treatment: Treatment is identical to the yellow patient, except that your “deep cleaning” is now done in quadrants (upper right, lower right, upper left, lower left). A minimum of two visits are needed to thoroughly eliminate all the bacterial debris under the gums and to condition your tissues for proper healing. Your re-evaluation appointment is extremely important. Please remember that your bone loss is now advanced. Dr. Beauchamp will discuss the future of your gums treatment. Only a dental professional can provide the service your mouth now needs. Your treatment will include a strong dose of patient education, frequent preventive maintenance, close monitoring of your condition, and specialized periodontal therapies custom-tailored for your particular needs. Your motivation is essential. Only YOU can demand this improvement.

PURPLE PATIENTS This is an accident at the intersection. The damage is done. Call the tow-truck and sweep the broken glass away!

Translation: You have “non-refractory periodontitis.” The boney support of your teeth is so severely damaged that the only hope is to remove the affected teeth and prepare the mouth for a denture or similar prosthesis.

Recommended treatment: Severely affected teeth are extracted (“pulled”) and the remaining bone is conditioned to receive a suitable replacement such as implants or partial dentures.

In retrospection, one can conclude that it is far better to travel at a cautious speed, than to risk one’s life and one’s health in a thrilling ride. What do you think?